History

Most patients with Scheuermann's disease present with a history of deformity. The parent brings the child to the physician because of poor posture or referral from a school screening program.

The incidence of pain is low, although 20% of patients may complain of discomfort in the region of the kyphosis. In patients with lumbar localization of kyphosis, the pain appears more pronounced—as many as 80% may report lower back pain. The pain is usually intermittent and is characterized as dull and aching; it is related generally to activity and is relieved by rest.
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Physical

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Patients with upper thoracic Scheuermann's disease present with a kyphotic deformity best demonstrated in the forward flexed position.

Decreased flexibility of the spine is noted, indicating the structural nature of the kyphotic deformity, in contrast to patients with flexible postural kyphosis.

Patients may have tenderness to palpation above and below the apex of the kyphosis.

A high association exists between scoliosis and Scheuermann's disease. Patients also may have a hyperlordosis in the lumbar spine.

Lower thoracic kyphosis is localized at the thoracolumbar junction; in general, any kyphotic deformity present at this level must be considered abnormal.

Hamstring tightness may be present in these patients.

A careful neurologic examination is recommended, although neurologic deficits are extremely rare.

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Causes

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Osteochondritis of the upper and lower cartilaginous vertebral plates has been incriminated in the development of Scheuermann's disease.